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3D Intracardiac Echocardiography in Mitral Transcatheter Edge-to-Edge Repair : When TEE Is Hard to Stomach

ABSTRACT: Intracardiac echocardiography (ICE) has historically had limited utility in complex structural interventions. Newer 3-dimensional ICE catheters have enhanced imaging and real-time functionality. We present a novel case of mitral valve transcatheter edge-to-edge repair where transesophageal imaging was limited by massive hiatal hernia and where complementary 3D ICE imaging enabled procedural success. (Level of Difficulty: Intermediate.) Central Illustration

SUBMITTER: Blusztein D

PROVIDER: S-EPMC9270632 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Percutaneous Mitral Valve Edge-to-Edge Repair Using Volume Intracardiac Echocardiography—First in Human Experience.

Project description:Highlights•First in human experience: percutaneous mitral valve repair (PMVR) procedure guided by three-dimensional volume intracardiac echocardiography (ICE).•Volume ICE adds valuable information to two-dimensional ICE•Further improvements such as wider opening angle of the volume ICE probe are needed for routine use in PMVR.

| S-EPMC6034481 | biostudies-other

Torrential Mitral Regurgitation After Transcatheter Edge-to-Edge Mitral Valve Repair.

Project description:A patient with severe mitral regurgitation and chronic systolic heart failure taking inotropic support at home presents for transcatheter edge-to-edge mitral valve repair, complicated by torrential mitral regurgitation from damaged mitral leaflets requiring escalating mechanical circulatory support and ultimately expedited orthotopic heart transplantation. (Level of Difficulty: Intermediate.).

| S-EPMC8305671 | biostudies-literature

Transcatheter Edge-to-Edge Repair for Severe Mitral Regurgitation With Double-Orifice Mitral Valve.

Project description:Double-orifice mitral valve (DOMV), a rare congenital heart disease, is the inspiration behind the transcatheter edge-to-edge repair (TEER). Here we report a successful TEER case in a patient with DOMV with severe regurgitation. The patient's symptoms were greatly improved after the procedure.

| S-EPMC10865215 | biostudies-literature

Transcatheter Tricuspid and Mitral Valve Edge-to-Edge Repair: The Double Double Orifice.

Project description:Highlights•Tricuspid regurgitation with mitral valve disease is associated with poor outcomes.•Transcatheter edge-to-edge repair of the tricuspid valve can be done successfully.•Intraprocedural echocardiography is essential for transcatheter tricuspid therapies.

| S-EPMC6200677 | biostudies-other

Prognostic value of hepatorenal function following transcatheter edge-to-edge mitral valve repair.

Project description:BackgroundHepatorenal dysfunction is a strong prognostic predictor in patients with heart failure. However, the prognostic impact of the hepatorenal dysfunction in patients undergoing transcatheter mitral valve repair (TMVR) has not been well studied.MethodsIn consecutive patients who underwent edge-to-edge TMVR at three German centers, the model for end-stage liver disease excluding international normalized ratio (MELD-XI) score was calculated as 5.11 × ln [serum total bilirubin (mg/dl)] + 11.76 × ln [serum creatinine (mg/dl)] + 9.44. Patients were stratified into high (> 11) or low (≤ 11) MELD-XI score of which an incidence of the composite outcome, consisting of all-cause mortality and heart failure hospitalization, within 2 years after TMVR was assessed.ResultsOf the 881 patients, the mean MELD-XI score was 11.0 ± 5.9, and 415 patients (47.1%) had high MELD-XI score. The MELD-XI score was correlated with male, effective regurgitant orifice area, and tricuspid regurgitation severity and inversely related to left ventricular ejection fraction. Patients with high MELD-XI score had a higher incidence of the composite outcome than those with low MELD-XI score (47.7% vs. 29.8%; p < 0.0001), and in multivariable analysis, the high MELD-XI score was an independent predictor of the composite outcome [adjusted hazard ratio (HR) 1.34; 95% confidence interval (CI) 1.02-1.77; p = 0.04). Additionally, the MELD-XI score as a continuous variable was also an independent predictor (adjusted HR 1.02; 95% CI 1.00-1.05; p = 0.048).ConclusionsThe MELD-XI score was associated with clinical outcomes within 2 years after TMVR and can be a useful risk-stratification tool in patients undergoing TMVR.

| S-EPMC8639570 | biostudies-literature

'Minimalist approach' for transcatheter mitral valve replacement using intracardiac echocardiography and conscious sedation: a case series.

Project description:Background:Transcatheter aortic valve implantation operators have adapted to a less invasive technique by foregoing the use of general anaesthesia and transoesophageal echocardiography. This is known as a 'minimalist approach'. This approach has yet to be explored in transcatheter mitral valve replacement (TMVR). Two patients with high perioperative risk underwent TMVR using only monitored conscious sedation (CS) and intracardiac echocardiography (ICE). Case summary:The patients were symptomatic and required treatment of severe mitral regurgitation and severe mitral stenosis in a mitral valve ring and prosthetic mitral valve, respectively. With the use of an antegrade transseptal approach, the procedure was conducted under CS using ICE only. After placement of the prosthetic mitral valve, the valve was assessed by advancing the ICE catheter through the interatrial septal defect and no significant paravalvular leak occurred. In one case, ad hoc treatment of right to left shunting was successfully pursued. Valve function was excellent immediately and at 24?h after implantation and resulted in significant haemodynamic improvement. Conclusion:With more TMVR cases being conducted, the 'minimalist approach' with CS and ICE may be considered in selected cases.

| S-EPMC7319820 | biostudies-literature

Transcatheter edge-to-edge mitral valve repair in functional mitral regurgitation: patient selection according to MITRA-FR and COAPT.

Project description: Not available

| S-EPMC6783759 | biostudies-literature

PASCAL mitral valve repair system versus MitraClip: comparison of transcatheter edge-to-edge strategies in complex primary mitral regurgitation.

Project description:BackgroundThe PASCAL system is a novel device for edge-to-edge treatment of mitral regurgitation (MR). The aim of this study was to compare the safety and efficacy of the PASCAL to the MitraClip system in a highly selected group of patients with complex primary mitral regurgitation (PMR) defined as effective regurgitant orifice area (MR-EROA) ≥ 0.40 cm2, large flail gap (≥ 5 mm) or width (≥ 7 mm) or Barlow's disease.Methods38 patients with complex PMR undergoing mitral intervention using PASCAL (n = 22) or MitraClip (n = 16) were enrolled. Primary efficacy endpoints were procedural success and degree of residual MR at discharge. The rate of major adverse events (MAE) according to the Mitral Valve Academic Consortium (MVARC) criteria was chosen as the primary safety endpoint.ResultsPatient collectives did not differ relevantly regarding pertinent baseline parameters. Patients` median age was 83.0 [77.5-85.3] years (PASCAL) and 82.5 [76.5-86.5] years (MitraClip). MR-EROA at baseline was 0.70 [0.68-0.83] cm2 (PASCAL) and 0.70 [0.50-0.90] cm2 (MitraClip), respectively. 3D-echocardiographic morphometry of the mitral valve apparatus revealed no relevant differences between groups. Procedural success was achieved in 95.5% (PASCAL) and 87.5% (MitraClip), respectively. In 86.4% of the patients a residual MR grade ≤ 1 + was achieved with PASCAL whereas reduction to MR grade ≤ 1 + with MitraClip was achieved in 62.5%. Neither procedure time number of implanted devices, nor transmitral gradient differed significantly. No periprocedural MAE according to MVARC occured.ConclusionIn this highly selected patient group with complex PMR both systems exhibited equal procedural safety. MitraClip and PASCAL reduced qualitative and semi-quantitative parameters of MR to an at least comparable extent.

| S-EPMC8639575 | biostudies-literature

National outcomes of urgent vs. non-urgent percutaneous edge-to-edge transcatheter mitral valve repair.

Project description:BackgroundThe current data regarding outcomes of transcatheter edge-to-edge mitral valve repair with the MitraClip system in the urgent setting has not been well described. Therefore, we sought to evaluate the outcomes of urgent MitraClip procedures compared with non-urgent ones.MethodThe Nationwide Inpatient Sample database years 2011-2017 was used to identify hospitalizations for MitraClip in the urgent setting. Propensity score matching was used to compare the patients who underwent MitraClip in urgent versus non-urgent settings.ResultsA total of 15,993 patients underwent the MitraClip procedures from 2011 to 2017. 3,929 (24.6%) were urgent and 12,064 (75.4%) were non-urgent. Patients in the urgent group were younger (75.08 vs 77.46) and more likely to be African American (p < 0.001). The urgent group had a higher burden of comorbidities such as diabetes, atrial fibrillation, renal failure and pulmonary circulatory disorders. Using multivariable logistic regression, there was no statistically significant difference in mortality between urgent and non-urgent groups (4.2% vs 1.8%, OR 0.64; 95% CI 0.41-1.00, p = 0.051). Using propensity score matching, there was no statistically significant difference in the in-hospital mortality between urgent and non-urgent groups (4.4% vs 2.8%, OR: 1.60, 95% CI: 0.71-3.63, p = 0.254). The risks of acute kidney injury and discharge to an outside facility were higher in the urgent group (p < 0.001).ConclusionNo significant in-hospital mortality for patients who underwent urgent versus non-urgent MitraClip procedures. Therefore, urgent MitraClip procedure might be an acceptable option when indicated.

| S-EPMC9294183 | biostudies-literature

Racial Disparities in Access to High-Volume Mitral Valve Transcatheter Edge-to-Edge Repair Centers.

Project description:BackgroundSevere mitral regurgitation is a progressive disease associated with high morbidity and mortality, and frequent readmissions for heart failure. Surgical mitral valve repair or replacement has been the gold-standard treatment; however, advances in transcatheter edge-to-edge repair (TEER) have provided alternatives for high-risk surgical patients. There are no data on racial disparities in access to high-volume TEER centers.MethodsData on TEER hospitalizations from New York, New Jersey, Maryland, North Carolina, Washington, Colorado, Arizona, and Florida were analyzed using the State Inpatient Databases for 2016. The baseline characteristics of patients who underwent TEER at high- (≥25 procedures per year) and low-volume centers were identified. The association between race and the likelihood of undergoing TEER at high-volume centers was assessed. The secondary outcomes were mortality and the frequency of home discharges.ResultsOf 1567 patients included in the analysis, 1129 underwent TEER at high-volume centers. Patients treated at high-volume centers had a higher prevalence of chronic kidney disease and congestive heart failure. Black and Hispanic patients were 59% (adjusted odds ratio [OR], 0.41; P < .001) and 51% (adjusted OR, 0.49; P < .001) less likely to undergo TEER at high-volume centers, respectively, compared with White patients. Hispanic patients were 3 times more likely to die during index admission than White patients (adjusted OR, 3.32; P = .027). There was geographic clustering of TEER centers, and a higher ratio of White patients to minority patients in zip codes with high-volume TEER centers.ConclusionsRacial minorities patients, particularly Black and Hispanic patients, are less likely to undergo TEER at high-volume centers. Hispanic patients experience higher rates of in-hospital mortality after TEER than White patients.

| S-EPMC11308692 | biostudies-literature

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